Healthcare Provider Details

I. General information

NPI: 1013142280
Provider Name (Legal Business Name): HAMPTON HEALTH LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CALIFORNIA ST STE. 470
SAN FRANCISCO CA
94109-4590
US

IV. Provider business mailing address

1700 CALIFORNIA ST STE. 470
SAN FRANCISCO CA
94109-4590
US

V. Phone/Fax

Practice location:
  • Phone: 415-202-9990
  • Fax: 415-843-0548
Mailing address:
  • Phone: 415-202-9990
  • Fax: 415-843-0548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberG59000
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN H FULLERTON
Title or Position: OWNER
Credential: M.D.
Phone: 415-202-9990